DentistryAndDiabetes…

What You Must KnowBefore Choosing a Dentist.

Re: Special Report

Dentistry and Diabetes:

What You Must Know Before Choosing a Dentist

No one enjoys going to the dentist, but for people with diabetes, getting that

cleaning and check-up are especially important. The link between diabetes

and oral health can't be ignored.

While everyone is prone to periodontitis, or diseases of the tissues

surrounding the teeth and gums, people with diabetes often have more severe

cases that can both cause and predict additional diabetic complications.

Defining Periodontitis

Periodontitis or periodontal diseases involve inflammation and destruction of

the tissues supporting and surrounding the teeth, including the gums and

supporting bone. Periodontitis destroys the periodontal ligaments or

connective tissue fibers that attach the tooth to the bone causing resorption of

the alveolar bone (tooth socket). Consequently, the gums swell, redden,

change shape, bleed, teeth loosen and pus forms. With the loss of soft tissue

and bony support, deep periodontal pockets may form that foster bacterial

growth.

The formation of plaque on the teeth is the first step toward periodontal

disease. Plaque, the white sticky substance that collects between teeth, is

often the start of periodontitis. Made of microorganisms, dead skin cells and

leukocytes (infection fighting white blood cells), it can be removed by

brushing and flossing regularly. If it is allowed to build up, it will harden and

turn into tartar. Tartar can only be removed with a professional cleaning at

the dentist's office. Both plaque and tartar make the gums vulnerable to

infection.

If an infection enters the gums it is referred to as gingivitis, the first stage of

periodontitis. Bacteria that collect and breed at the gum line and the groove

between the gum and the tooth cause the gums to redden, swell and bleed.

This response is normal but can also lead to periodontitis. Gums affected by

gingivitis often bleed and are sensitive, but not always. Other signs include

swollen gums, loose teeth, a bad taste in the mouth and persistent bad

breath.

The Relationship to BG Control

BG control and good oral hygiene seems to be the key to avoiding most dental

complications. Everyone is at risk of developing periodontal disease, but all

people with diabetes, regardless of age or type of diabetes, are more

susceptible. There are several reasons for this.

For one, people with diabetes have

more sugar in the mouth that provides

a more hospitable environment for

hostile bacteria. This makes all forms

of periodontal disease more likely.

High and fluctuating BGs are also a big

factor in the increased risk of

periodontal disease. Poor BG control

means higher degrees of periodontitis

and more vulnerability to

complications.

It also makes healing more difficult once an infection sets in. Just like

diabetics with poor BG control have a hard time healing wounds and infections

on their feet, their bodies have a hard time fighting infections and healing

wounds in the mouth.

At the same time, on-going infections may make BG control more difficult.

Inflammation and infection affect BG control no matter where they occur. But

the mouth is often overlooked, as most doctors do not look in the mouth.

Once an infection takes root a vicious cycle ensues making metabolic and

infection control a struggle. This cycle can have drastic consequences. If oral

infections get out of control they can lead to BG control problems serious

enough to land a person with diabetes in the hospital, to say nothing of the

damage to the teeth and gums.

Gum infections can also impact insulin needs. Authors of a study cited in

September's 1997's Practical Diabetology concluded that when an infection is

rampant, patients with diabetes often have increased insulin requirements. If

periodontal disease is treated and gingival inflammation is eliminated, these

insulin needs often decrease.

Collagen, which is a building block of the tissue that attaches teeth to bones

and the surrounding soft tissue, is also affected by diabetes. Diabetes' effect

on collagen metabolism may make an infection potentially more destructive.

Reduced Salivary Flow

Patients with diabetes may also experience dry mouth as a result of reduced

saliva. Neuropathy and certain medications may be the cause of reduced

salivary flow. Saliva is important to wash residue off teeth and gums and

prevent tooth and gum disease. Ask the dentist about products that moisten

the mouth or increase saliva.

Drinking lots of fluids may help alleviate the problem and there are products

available that can help keep the mouth moist.

It's All Connected

The development of periodontal disease may reflect the presence of other

problems related to BG control such as retinopathy.

Retinopathy and dental problems are closely related. If you look at a

population that is having eye problems, that same population is likely to have

dental problems. If a person is diagnosed with retinopathy, they should make

sure that their mouth is being examined and the gums are healthy.

Conversely, if there is serious gum disease there may be other diabetic

complications taking place in the body.

Problems that begin elsewhere in the body should also provide clues for health

care professionals. The presence of microalbuminuria and neuropathy are

signals to check the mouth for potential complications.

Prevention

As with all diabetic complications, an

ounce of prevention is worth its weight in

gold. By far the most important step

that can be taken is to brush and floss

regularly. It is advisable to discuss

proper brushing and flossing

techniques with your dental team.

Some of the fundamentals might

surprise you. For example, it is

recommended that you brush for a

minimum of three minutes, which,

when put into practice, is longer than

one might imagine.

In the Chair

Prevention also includes making and keeping the often-dreaded dental

appointment. We suggest seeing the dentist twice a year, or as often as

necessary. If you are avoiding the dentist due to fear and or loathing, here

are some strategies to make it a little easier to deal with.

It is best to schedule dental appointments,

about an hour and a half after breakfast so

that the appointment does not interfere with

regular meal times. Test your BGs before

you go to the dentist and test them while

you are at the dentists office. Make sure to

stick to your regular insulin and/or oral

medication schedule to avoid BG problems.

It is also important to discuss your diabetes

with your dental team.

Once at the dentist, voice concerns and

report any abnormality, such as gingival

bleeding. Healthy gums are usually light-

pink, snug around the tooth and don't bleed.

Treatment

If an infection is already present, it must be treated before any significant

procedures can be attempted. Once diabetes is under good control, oral

surgery can be performed without complication.

Dentures

Since periodontal disease can lead to tooth loss, many patients are fitted for

dentures. Patients wearing complete dentures should see the dentist once a

year to examine all soft tissue areas. Partial dentures require attention to

hygiene just like real teeth. They need to be removed and cleaned daily.

Wearing dentures continuously and failing to take the proper precautions can

promote the growth of mouth fungus (candidal colonization) leading to thrush.

Dentures may also be ill-fitting and uncomfortable. This is because the gums

of people with diabetes may be especially sensitive. This in turn makes eating,

and maintaining good health and proper BG control more difficult.

Dental implants can be another viable option for tooth replacement for people

with diabetes.

Taking Precautions

Dental therapy for people with diabetes does not have an established criteria,

although dental offices record medical conditions such as diabetes they may

not be prepared for an emergency resulting from diabetes. It is important to

discuss your diabetes and possible low and

high blood sugar scenarios with your dental

team.

The dental team needs to know if their

patients take oral agents or insulin because

that means special precautions must be

taken. Dentists caring for patients with

diabetes should have a calibrated glucose

meter, glucose tablets or fruit juice, and a

glucagon kit available.

They should also be familiar with the

common signs of hypoglycemia such as loss

of coordination, blurry vision, palpitations, rapid heart rate, sweating and

shaking. He also suggests finding out if a patient with diabetes has

hypoglycemic unawareness, a condition in which they experience few if any

signs and symptoms of low blood sugars.

A common situation leading to hypoglycemia at the dental office is a patient

skipping breakfast before an appointment but taking the regular amount of

insulin.

Severe hyperglycemia may occur as well, but less frequently. Acetone breath

and dehydration, dry mucous membranes and changes in mental status are

signs that blood glucose is too high and dental procedures should be

postponed.

Read this patient’s story to understand the

dental-health to diabetes connection…

“I’ll dance at your wedding…”

Sure, I know it’s a long time down the road. But, when my daughter, or my

son, decides to get married, I’m going to be healthy enough to dance.

And, I plan on dancing all night long.

I lost my father to complications from diabetes and when I thought

about my family and my responsibilities to them, I was downright

scared. My father was in his early 50's and I am now 38. So, when I

noticed this winter that I was constantly thirsty and feeling run down, I

decided to get it checked out.

I decided to visit my regular doctor. During the appointment, I had several

tests completed that officially diagnosed me with diabetes. He prescribed

medication, exercise, and diet.

The exercise and diet part are probably the hardest part of my treatment

program. I now have to get up and move instead of sitting on the couch

watching countless hours of TV with a bag of potato chips. But I made a

promise to myself and to my family.

I also decided to visit a new dentist for a check-up. A friend of mine told

me that there is a possible link between diabetes and periodontal disease;

also known as gum disease and I wanted to cover all of my bases.

The dentist said he was glad that I was taking an active role because I

did indeed have the beginnings of periodontal disease and he said I

should be treated. I once again thought about my kids and dancing at

their weddings, about holding my first grandchild, and maybe seeing my

grandkids get married.

So, I knew in addition to the exercise, good diet, and medication from

my doctor, I was going to have to take more drastic steps and treat my

periodontal disease with regular periodontal treatment sessions.

I decided to go with the non-surgical route to treat my gum disease. This

involved treatment to remove plaque and calculus through scaling. I also

started using a special toothpaste and mouthwash. And, of course, that

old, reliable enemy of gum disease – flossing.

I am so happy with my decision. It was scary to go through some of the

tests, but I know with my hard work and regular visits to the dentist I

will be there to walk my daughter down the aisle.

I'm already starting to feel better. I want to always be there for my kids

and that's why I'm so happy I've decided to take charge of my health -

including my oral health.

How to choose a dentist if you are diabetic

For years you’ve visited the same dental office for your regular cleanings and

the occasional cavity. You’ve had few complaints about your care—certainly

none big enough to merit changing dentists. But recently you’ve moved, or

your dentist has retired, or your insurance plan has changed, and you’re

obliged to make a switch. You know that finding a good dental team is

important, so how do you begin the search? What do you look for in a dentist

and dental hygienist?

Obviously, the practitioners’ skills and the safety precautions and technology

employed in the office are important criteria. Then there are practical

considerations, such as the proximity of the office to your home or workplace,

the office hours, accepted insurance plans, fees, payment policy, and ability to

accommodate emergencies. A comfortable office environment also matters,

particularly if you have any anxiety about dental work. You want a dental

team with a good “chair side manner,” one that is willing to listen to your

concerns, answer your questions, and explain what they’re doing and why.

Few of these details can be found by flipping through listings for dentists in

the phone book. Finding the right dental-care provider will take some time

and research, and it is best done under non-emergency conditions. Start your

search well before you’re due for a checkup.

Background information

A dentist’s technical skills are of utmost importance, but evaluating these

skills is not always easy for someone who is not a dental professional. One

sign of professional commitment, however, is membership in a professional

dental organization such as the American Dental Association (ADA) or a state

dental association. The dentist’s receptionist should be able to tell you over

the telephone if the dentist maintains such a membership.

When you call a dentist’s office, it’s perfectly all right to ask the receptionist

his or her name and how long he or she has worked with the dentist. Does the

receptionist sound professional and courteous? Does he or she seem proud of

and knowledgeable about the practice? If the dentist treats his staff well and

his dentistry is of high caliber, employees tend to brag a little, which is usually

a good sign. Any reluctance on the part of the staff to answer your questions,

on the other hand, is a worrisome sign.

When you visit an office, take a look around. Dentists who are proud of their

work may display “before and after” photos in a photo album or on the walls

in the reception area. You can

sometimes tell if the dentist’s

work is not just cosmetically

admirable but also technically

sound by looking at the gums in

the “after” photos. Healthy gums

are pale pink, not bright red. A

conscientious dentist will not do

cosmetic work if a person’s gums

are in poor condition. If the gums look unhealthy in the “after” photo, it

should raise a red flag in your mind.

The comprehensive oral exam

Your first appointment with a new dentist should be a comprehensive oral

exam, an in-depth screening that enables the dentist to complete your dental

records and develop a treatment plan for you. This is a good time to evaluate

a dentist’s manner and care and to make sure that this office is right for you.

Take note of the equipment used, too. A dentist who relies on older

techniques can provide excellent care, but newer technology, some of which is

described in this article, can make checkups faster, less painful, and more

thorough.

To begin with, the dentist should take your medical and dental history,

recording information about your previous dental work, any medical

conditions or illnesses you have (or had), medicines you currently take, and

allergies you have. (If you have an allergy to latex, mention it when you make

the appointment so the office can prepare for your visit.) It’s important that

you state how long you have had diabetes, how you control it, and any

problems or difficulties you have had recently. The dentist or dental hygienist

should follow up on these questions at every visit.

Take Action Now!

We offer a full range of dental services and we absolutely never pressure

our patients. Ultimately our only job is to make sure you have all the information

you need to make an informed decision.

So call today and start on the road to a more confident you!

Call our office today!

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